- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.00 / $1,768.00 / $4,100.00
| Facility | | $1,100.00 | $1,768.00 | $4,100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,335.71 / $1,469.24 / $1,646.47
| Professional | | $1,335.71 | $1,469.24 | $1,646.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,455.92 / $16,329.40 / $21,968.27
| Facility | | $13,455.92 | $16,329.40 | $21,968.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.00 / $1,754.00 / $5,201.00
| Facility | | $650.00 | $1,754.00 | $5,201.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,552.85 / $2,137.09 / $3,250.62
| Professional | | $1,552.85 | $2,137.09 | $3,250.62 |